Provider Demographics
NPI:1457433781
Name:HORN INVESTMENTS
Entity type:Organization
Organization Name:HORN INVESTMENTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:228-281-0790
Mailing Address - Street 1:8216 BELLE FONTAINE DR.
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564
Mailing Address - Country:US
Mailing Address - Phone:228-281-0790
Mailing Address - Fax:601-724-8656
Practice Address - Street 1:8216 BELLE FONTAINE DR.
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-281-0790
Practice Address - Fax:601-724-8656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORN INVESTMENTS, DBA STONEY CREEK PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010026533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457433781Medicaid
2133020OtherPK